What Is Vascular Entrapment?
Vascular entrapment syndromes at the elbow level can occur occasionally. These entrapments
typically happen to the brachial artery in the cubital fossa or in between the biceps and triceps
muscles in the upper arm. Symptoms vary and can be described as an intense burning or throbbing pain in the arms or a feeling of coldness and loss of blood flow into the hands and fingertips. The symptoms typically vary due to severity and location of the vascular entrapment. The most common structure causing compression of the brachial artery in the cubital fossa is the pronator teres muscle. Typically, this is the result from repetitive overuse injuries resulting from long term
Arterial entrapment syndrome (AES) at elbow level is very rare and to our knowledge, no case of AES by lacertus fibrosis in the cubital fossa in presence of brachial artery duplication has been described to date. We describe a rare case of acute arterial thrombosis of one of two brachial arteries highlighted in the cubital fossa which developed after strenuous right elbow flexor muscle activity and hyper-extensions presumably related to AES by lacertus fibrosis at elbow level.
Clinical examination evidenced the absence of radial artery pulse in the wrist and mild hypothermia in the second and third finger. During surgical exploration, two anastomosed brachial arteries were detected in the cubital fossa under the lacertus fibrosis. The lateral superficial brachial artery was occluded. Intraoperative arteriography evidenced brachial artery duplication at the third superior of the arm and normal vascular pattern at the forearm level. In cases of unexplained atypical intermittent upper extremity claudication or acute ischemic symptoms, an AES should always be ruled out, particularly when symptoms are exacerbated by strenuous upper extremity activity or when upper limb muscular hypertrophy is evident. In these cases, a thorough dynamic clinical and instrumental examination is mandatory to confirm a diagnosis of AES and to avoid possible future ischemic complications.